Medical Referral Coordinator

Job Description

Job Description

Gupta Medical Center / Ramona Specialists
Location: San Jacinto, CA
Position: Full-Time Medical Referral Coordinator
Schedule: Monday–Friday

• Managed care authorization experience — IEHP, Medi-Cal managed care, Medicare Advantage, and commercial plans
• eClinicalWorks (eCW) experience — able to work in our EMR without heavy training
• Ability to independently manage referrals through completion — initiation → authorization → appointment → consult report → closure, without being chased

If those three describe you, we want to talk.

• Process referrals to specialists, diagnostic facilities, and other healthcare providers promptly
• Obtain and track insurance authorizations, including IEHP, Medi-Cal managed care, Medicare Advantage, and commercial insurance plans
• Contact patients regarding referral status, authorizations, scheduling, and follow-up instructions
• Perform and document 72-hour referral follow-up and subsequent follow-ups according to office policy
• Track referrals from initiation through specialist appointment, consultation report receipt, and appropriate closure
• Maintain accurate and timely referral documentation in the electronic medical record
• Follow up with insurance companies, specialists, and diagnostic facilities regarding pending referrals
• Identify missing information and communicate promptly with providers and clinical staff
• Monitor pending, delayed, denied, and incomplete referrals and escalate unresolved issues
• Maintain referral tracking reports and assist with quality assurance and health plan audits
• Coordinate effectively with front-office, back-office, and clinical staff

Additional Responsibilities

• Willingness to assist with incoming telephone calls, patient inquiries, and appointment scheduling as needed
• Flexibility to assist with front-office duties, administrative tasks, and other office workflows as assigned
• Ability to multitask and adjust priorities according to patient care and office needs

• Managed care authorization experience strongly preferred — IEHP, Medi-Cal, Medicare Advantage, and commercial plans
• eClinicalWorks (eCW) experience strongly preferred
• Demonstrated ability to independently manage referrals from initiation through closure
• Previous experience in medical referrals and insurance authorizations
• Understanding of medical terminology, ICD-10 codes, and referral workflows
• Strong organizational, communication, and time-management skills
• Ability to manage multiple referrals and meet established deadlines
• Detail-oriented with accurate documentation skills
• Ability to work independently and cooperatively with providers and staff
• Familiarity with HIPAA and patient confidentiality requirements

Professional Expectations

• Maintain professional, courteous, and respectful communication with physicians, providers, management, coworkers, and patients
• Follow established office policies, procedures, and management instructions
• Demonstrate a cooperative, team-oriented attitude and willingness to assist other departments when needed
• Communicate concerns constructively and seek clarification when necessary
• Accept feedback professionally and demonstrate willingness to learn and adapt to workflow improvements
• Maintain a positive, dependable, and patient-focused approach in a busy medical office

Benefits

• Competitive compensation based on experience ($20–$24/hour)
• Full-time position, Monday–Friday
• Benefits according to company policy